How Does An Adult SALT Assessment Work?

AD. There are lots of reasons that adults might experience speech or language difficulties, but in most cases, this is caused by illness or injury, such as strokes, neurological disorders, brain injuries or degenerative diseases. Either way, speech and language therapy (SALT) is the best solution to overcoming these challenges. Before a full therapy plan can be put in place, a SALT assessment must be carried out by an expert in the field. This will enable the chosen therapist to identify the key difficulties the adult is experiencing. But how exactly does an adult SALT assessment work? In this guide, we’re going to explore the purpose, process and outcomes of a SALT assessment in more detail to give you a clearer understanding of what to expect.

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The purpose of an Adult SALT assessment

In order to set out an effective SALT plan and help clients overcome their difficulties, therapists must first diagnose any speech, language, voice, fluency or swallowing disorders they are experiencing. 

This is the purpose of a SALT assessment. To identify communication difficulties, such as issues with speech production, understanding, and social communication, as well as allowing the therapist to assess more physical challenges, like swallowing function and safety. 

Armed with this information, they can provide a more detailed diagnosis of the key problems and guide intervention strategies and activities. This will support the client’s rehabilitation and improve their quality of life.

The step-by-step process 

An adult SALT assessment must be comprehensive and varies based on the individual’s needs and symptoms. However, it generally includes the following steps: 

1. A referral and initial consultation 

A SALT assessment begins with a referral, usually from a GP, neurologist or another healthcare professional. 

That said, individuals can self-refer if they recognise difficulties with their own speech, language or swallowing and want some answers. Nowadays, online speech therapy makes it much easier for adults to self-refer and find the right therapist to work with. 

Once a referral or introduction has been made, an initial consultation will be arranged. This involves gathering background information, and the therapist will typically ask for the following: 

• Their medical history, including any neurological conditions, surgeries, injuries or previous speech therapy
• The current difficulties with speech, language or swallowing, they have noticed
• Any daily communication challenges they experience 
• The personal and professional impact these communication issues are having on their lives

This step involves an in-depth discussion that enables the therapist to understand the individual’s experiences and concerns. 

2. An observational assessment

The next step is for the therapist to observe the individual’s speech, language and swallowing in natural conversation using structured tasks. At this stage, they will assess:

• Clarity of speech
• Fluency and coherence
• Non-verbal communication skills
• Signs of distress or discomfort during swallowing

3. Speech and language testing

The next stage of the process is a formal evaluation. This involves standardised tests that are used to assess:

• Speech production: Examining articulation, phonation and intelligibility
• Language comprehension and expression: The ability to understand spoken and written language, as well as the ability to express thoughts verbally and in writing
• Voice quality: Evaluating pitch, volume and resonance
• Cognitive-communication skills: Testing memory, attention and problem-solving abilities related to communication
• Fluency and stuttering: Identifying stuttering or disruptions in speech flow

4. Swallowing assessment (also known as a dysphagia assessment)

If the individual reports any swallowing difficulties, a swallowing assessment is conducted as part of the larger SALT assessment. 

This is typically broken down into two tasks, the first being a clinical bedside swallow assessment. This is used to observe how the individual swallows liquids and solids.

Then, there is the instrumental assessment using techniques like videofluoroscopy or fiberoptic endoscopic evaluation of swallowing (FEES) for a more detailed analysis of what’s going on physically. 

5. Functional communication assessment

The final step in the process evaluates how effectively the individual communicates in everyday situations. This part of the assessment will focus on:

• Use of gestures, facial expressions and non-verbal communication methods
• Ability to initiate and maintain conversations
• Social and pragmatic language skills

What happens after the initial assessment? 

Once an adult has completed all of the steps above and the therapist has gathered as much information as they can, it’s time for a diagnosis. They will compile all their findings to provide the individual with a clear and detailed diagnosis. 

These results will help them determine the severity of their communication or swallowing difficulties and any underlying causes if they have not already been diagnosed.

Not only this, but the assessment will enable the therapist to provide the best course of intervention, whether that’s ongoing therapy or assistive technology.

Intervention and therapy 

If ongoing therapy is the answer, the therapist will use the results from the SALT assessment to create a personalised treatment plan. This may include: 

• Exercises or tasks to improve articulation, voice control and fluency
• Strategies for improving comprehension, expression and social communication
• Techniques and dietary modifications to enhance swallowing safety if this is a key problem 
• Communication aids, such as speech-generating devices or picture boards

Follow-up and monitoring after the SALT assessment  

Even after the assessment is complete and a treatment plan has been set out, regular follow-up sessions are important to ensure the client’s progress is tracked and interventions are adjusted accordingly. 

The therapist may also collaborate with other healthcare professionals, such as occupational therapists and dietitians, to provide holistic care for the individual. 

In summary 

An adult speech and language therapy assessment is a structured yet flexible process that is designed to identify and address communication and swallowing challenges. 

Although these assessments tend to follow a similar structure each time: referral, observational assessment, speech and language testing, swallowing assessment, and functional communication assessment, these are always tailored to the individual's personal challenges and medical history. 

By gathering as much information as possible and understanding their unique needs in this way, the assessment facilitates effective interventions and an ongoing treatment plan. 

This can enhance the individual's communication abilities and improve their overall well-being, as well as help them overcome any speech and language difficulties they are facing.